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American Journal of Obstetrics and... Jun 2024Women can develop posttraumatic stress disorder in response to experienced or perceived traumatic, often medically complicated, childbirth; the prevalence of these... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Women can develop posttraumatic stress disorder in response to experienced or perceived traumatic, often medically complicated, childbirth; the prevalence of these events remains high in the United States. Currently, no recommended treatment exists in routine care to prevent or mitigate maternal childbirth-related posttraumatic stress disorder. We conducted a systematic review and meta-analysis of clinical trials that evaluated any therapy to prevent or treat childbirth-related posttraumatic stress disorder.
DATA SOURCES
PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible trials published through September 2023.
STUDY ELIGIBILITY CRITERIA
Trials were included if they were interventional, if they evaluated any therapy for childbirth-related posttraumatic stress disorder for the indication of symptoms or before posttraumatic stress disorder onset, and if they were written in English.
METHODS
Independent coders extracted the sample characteristics and intervention information of the eligible studies and evaluated the trials using the Downs and Black's quality checklist and Cochrane's method for risk of bias evaluation. Meta-analysis was conducted to evaluate pooled effect sizes of secondary and tertiary prevention trials.
RESULTS
A total of 41 studies (32 randomized controlled trials, 9 nonrandomized trials) were reviewed. They evaluated brief psychological therapies including debriefing, trauma-focused therapies (including cognitive behavioral therapy and expressive writing), memory consolidation and reconsolidation blockage, mother-infant-focused therapies, and educational interventions. The trials targeted secondary preventions aimed at buffering childbirth-related posttraumatic stress disorder usually after traumatic childbirth (n=24), tertiary preventions among women with probable childbirth-related posttraumatic stress disorder (n=14), and primary prevention during pregnancy (n=3). A meta-analysis of the combined randomized secondary preventions showed moderate effects in reducing childbirth-related posttraumatic stress disorder symptoms when compared with usual treatment (standardized mean difference, -0.67; 95% confidence interval, -0.92 to -0.42). Single-session therapy within 96 hours of birth was helpful (standardized mean difference, -0.55). Brief, structured, trauma-focused therapies and semi-structured, midwife-led, dialogue-based psychological counseling showed the largest effects (standardized mean difference, -0.95 and -0.91, respectively). Other treatment approaches (eg, the Tetris game, mindfulness, mother-infant-focused treatment) warrant more research. Tertiary preventions produced smaller effects than secondary prevention but are potentially clinically meaningful (standardized mean difference, -0.37; -0.60 to -0.14). Antepartum educational approaches may help, but insufficient empirical evidence exists.
CONCLUSION
Brief trauma-focused and non-trauma-focused psychological therapies delivered early in the period following traumatic childbirth offer a critical and feasible opportunity to buffer the symptoms of childbirth-related posttraumatic stress disorder. Future research that integrates diagnostic and biological measures can inform treatment use and the mechanisms at work.
Topics: Humans; Stress Disorders, Post-Traumatic; Female; Pregnancy; Parturition; Cognitive Behavioral Therapy
PubMed: 38122842
DOI: 10.1016/j.ajog.2023.12.013 -
Current Cardiology Reports Jun 2023To provide an update of the current evidence of cardiac disease-induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events. (Review)
Review
PURPOSE OF REVIEW
To provide an update of the current evidence of cardiac disease-induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events.
RECENT FINDINGS
A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from "traditional" PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions.
Topics: Humans; Stress Disorders, Post-Traumatic; Cardiovascular Diseases; Acute Disease; Life Style; Acute Coronary Syndrome
PubMed: 37129760
DOI: 10.1007/s11886-023-01870-1 -
The American Journal of Medicine Jun 2021
Topics: Burnout, Professional; COVID-19; Humans; Pandemics; Stress Disorders, Post-Traumatic
PubMed: 33737058
DOI: 10.1016/j.amjmed.2021.02.006 -
Psychological Medicine Oct 2021Posttraumatic stress disorder (PTSD) is a complex mental disorder afflicting approximately 7% of the population. The diverse number of traumatic events and the wide... (Review)
Review
Posttraumatic stress disorder (PTSD) is a complex mental disorder afflicting approximately 7% of the population. The diverse number of traumatic events and the wide array of symptom combinations leading to PTSD diagnosis contribute substantial heterogeneity to studies of the disorder. Genomic and complimentary-omic investigations have rapidly increased our understanding of the heritable risk for PTSD. In this review, we emphasize the contributions of genome-wide association, epigenome-wide association, transcriptomic, and neuroimaging studies to our understanding of PTSD etiology. We also discuss the shared risk between PTSD and other complex traits derived from studies of causal inference, co-expression, and brain morphological similarities. The investigations completed so far converge on stark contrasts in PTSD risk between sexes, partially attributed to sex-specific prevalence of traumatic experiences with high conditional risk of PTSD. To further understand PTSD biology, future studies should focus on detecting risk for PTSD while accounting for substantial cohort-level heterogeneity (e.g. civilian v. combat-exposed PTSD cases or PTSD risk among cases exposed to specific traumas), expanding ancestral diversity among study cohorts, and remaining cognizant of how these data influence social stigma associated with certain traumatic events among underrepresented minorities and/or high-risk populations.
Topics: Combat Disorders; Gene-Environment Interaction; Genome-Wide Association Study; Genomics; Humans; Neuroimaging; Prevalence; Stress Disorders, Post-Traumatic
PubMed: 33583458
DOI: 10.1017/S0033291721000210 -
Clinical Gerontologist 2019: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas:... (Review)
Review
: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. : We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners. : Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes). : PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited. : Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.
Topics: Aged; Aged, 80 and over; Cognitive Aging; Cognitive Dysfunction; Community Mental Health Services; Comorbidity; Female; Humans; Male; Middle Aged; Military Health; Prevalence; Psychotherapy; Randomized Controlled Trials as Topic; Stress Disorders, Post-Traumatic; Terminal Care; United States; Veterans; Wounds and Injuries
PubMed: 30422749
DOI: 10.1080/07317115.2018.1539801 -
Journal of Clinical Psychology Feb 2022Research examining the relationship between loneliness and Complex Posttraumatic Stress Disorder (CPTSD) is scarce, particularly among older adults. CPTSD includes the...
OBJECTIVES
Research examining the relationship between loneliness and Complex Posttraumatic Stress Disorder (CPTSD) is scarce, particularly among older adults. CPTSD includes the core symptoms of PTSD along with additional symptoms reflecting "disturbances in self-organisation" (DSO). This study examined the cross-sectional relationships between loneliness (emotional and social loneliness) and CPTSD symptoms (i.e., PTSD and DSO symptoms) in older adults.
METHODS
Structural equation modelling was used to examine these relationships in a nationally representative sample of US adults aged 60-70 years (n = 456).
RESULTS
Controlling for covariates, emotional loneliness was associated with PTSD (β = 0.31) and DSO (β = 0.57) symptoms whereas social loneliness was only associated with DSO symptoms (β = 0.25). The model explained 35.0% of the variance in PTSD symptoms and 71.3% in DSO symptoms.
CONCLUSION
These findings have important implications for treating and understanding PTSD/CPTSD and their correlates among older adults.
Topics: Aged; Emotions; Humans; International Classification of Diseases; Latent Class Analysis; Loneliness; Personality; Stress Disorders, Post-Traumatic
PubMed: 34287862
DOI: 10.1002/jclp.23225 -
Current Opinion in Anaesthesiology Oct 2022Dysfunction of fear memory systems underlie a cluster of clinically important and highly prevalent psychological morbidities seen in perioperative and critical care... (Review)
Review
PURPOSE OF REVIEW
Dysfunction of fear memory systems underlie a cluster of clinically important and highly prevalent psychological morbidities seen in perioperative and critical care patients, most archetypally posttraumatic stress disorder (PTSD). Several sedative-hypnotics and analgesics are known to modulate fear systems, and it is theoretically plausible that clinical decisions of the anesthesiologist could impact psychological outcomes. This review aims to provide a focused synthesis of relevant literature from multiple fields of research.
RECENT FINDINGS
There is evidence in some contexts that unconscious fear memory systems are less sensitive to anesthetics than are conscious memory systems. Opiates may suppress the activation of fear systems and have benefit in the prevention of PTSD following trauma. There is inconsistent evidence that the use of propofol and benzodiazepines for sedation following trauma may potentiate the development of PTSD relative to other drugs. The benefits of ketamine seen in the treatment of major depression are not clearly replicated in PTSD-cluster psychopathologies, and its effects on fear processes are complex.
SUMMARY
There are multiple theoretical mechanisms by which anesthetic drugs can modulate fear systems and clinically important fear-based psychopathologies. The current state of research provides some evidence to support further hypothesis investigation. However, the absence of effectiveness studies and the inconsistent signals from smaller studies provide insufficient evidence to currently offer firm clinical guidance.
Topics: Anesthesia; Fear; Humans; Hypnotics and Sedatives; Ketamine; Stress Disorders, Post-Traumatic
PubMed: 35993581
DOI: 10.1097/ACO.0000000000001176 -
Clinical Nurse Specialist CNSThe purpose of this study was to examine if a relationship exists between the coronavirus 2019 pandemic and posttraumatic stress disorder in clinical nurse specialists.
PURPOSE
The purpose of this study was to examine if a relationship exists between the coronavirus 2019 pandemic and posttraumatic stress disorder in clinical nurse specialists.
DESIGN
The study used a nonexperimental, correlational, cross-sectional design to explore the relationship between exposure to the coronavirus 2019 pandemic and posttraumatic stress disorder signs and symptoms.
METHODS
The National Association of Clinical Nurse Specialists distributed the electronic survey from August to October 2020. State affiliates and accrediting bodies distributed the survey from October to December 2020. The survey consisted of the Impact of Events Scale - Revised, which measures signs and symptoms of posttraumatic stress disorder. The target sample size was at least 100.
RESULTS
Statistically significant relationships were identified between the participant demographics, coronavirus 2019 exposure, and signs and symptoms of posttraumatic stress disorder in clinical nurse specialists. Of 129 participants, 30% had Impact of Events Scale - Revised scores that are clinically concerning for posttraumatic stress disorder.
CONCLUSIONS
Clinical nurse specialists can guide policy, practice, and education interventions to combat posttraumatic stress disorder due to the coronavirus 2019 pandemic.
Topics: COVID-19; Cross-Sectional Studies; Humans; Nurse Clinicians; Pandemics; Stress Disorders, Post-Traumatic
PubMed: 35714320
DOI: 10.1097/NUR.0000000000000679 -
European Journal of Psychotraumatology 2023Childbirth is a major life event with expected positive outcomes, yet for some women postnatal psychopathological symptoms may harm women's interpersonal relationships....
Childbirth is a major life event with expected positive outcomes, yet for some women postnatal psychopathological symptoms may harm women's interpersonal relationships. We hypothesized that higher levels of postnatal depression, post-traumatic stress (PTSD) symptoms, and fear of childbirth would be associated with mother-baby bond disorders and relationship dissatisfaction in couples. A cross-sectional self-report online questionnaire was used to survey partnered women who had delivered in the year prior to the study. We used a convenience sample of 228 women recruited through purposive and snowball sampling. Childbirth experience, PTSD symptoms, attachment style, depression, mother-baby bond disorders, and couple relationship dissatisfaction were measured. Women with higher PTSD and postnatal depression scores reported higher levels of mother-baby bond disorders-a relationship fully mediated by postnatal depression symptoms. Women who perceived childbirth as fearful or anxiety provoking had higher levels of PTSD and postnatal depression symptoms. Fearful and anxious birth perception was positively associated with mother-baby bond disorders-an association partly mediated by PTSD symptoms. Insecure attachment style was not found to be significantly associated with fearful or anxious perceptions of childbirth. Women who have postnatal PTSD/depression are less inclined to participate in a study of this nature. Also, online surveys prevented the use of clinical diagnoses of PTSD and depression. Our results suggest that PTSD and postnatal depression affect women's mental health and family bonding. Women should be assessed for negative traumatic birth experiences, PTSD, and depression, to allow targeted observation for psychopathologies and therapeutic interventions.
Topics: Pregnancy; Infant; Female; Humans; Depression, Postpartum; Cross-Sectional Studies; Stress Disorders, Post-Traumatic; Parturition; Family Relations
PubMed: 37052080
DOI: 10.1080/20008066.2022.2157481 -
The International Journal of Eating... Jun 2023Many individuals diagnosed with an eating disorder (ED) have been exposed to traumatic events, and some of these individuals are diagnosed with posttraumatic stress... (Review)
Review
OBJECTIVE
Many individuals diagnosed with an eating disorder (ED) have been exposed to traumatic events, and some of these individuals are diagnosed with posttraumatic stress disorder (PTSD). Although theorized by researchers and clinicians, it is unclear whether traumatic event exposure or PTSD interferes with outcomes from ED treatment. The objective of the current study was to systematically review the literature on traumatic events and/or PTSD as either predictors or moderators of psychological treatment outcomes in EDs.
METHOD
A PRISMA search was conducted to identify studies that assessed the longitudinal association between traumatic events or PTSD and ED outcomes. Eighteen articles met the inclusion criteria for review.
RESULTS
Results indicated that traumatic event exposure was associated with greater ED treatment dropout, but individuals with a traumatic event history benefited from treatment similarly to their unexposed peers. Findings also indicated that traumatic events may be associated with greater symptom relapse posttreatment.
DISCUSSION
Given the limited number of studies examining PTSD, results are considered very tentative; however, similar to studies comparing trauma-exposed and nontrauma-exposed participants, individuals with PTSD may have similar treatment gains compared to individuals without PTSD, but individuals with PTSD may experience greater symptom relapse posttreatment. Future researchers are encouraged to examine whether trauma-informed care or integrated treatment for EDs and PTSD mitigates dropout from treatment and improves symptom remission outcomes. Furthermore, researchers are encouraged to examine how the developmental timing of traumatic events, self-perceived impact of trauma, and cumulative trauma exposure may be associated with differential ED treatment outcomes.
PUBLIC SIGNIFICANCE
Eating disorders (EDs), trauma, and posttraumatic stress disorder (PTSD) often co-occur. Individuals with traumatic event exposure and/or PTSD demonstrate greater ED symptoms; it is unclear whether these individuals benefit similarly in ED treatment to their peers. The current study found that individuals with traumatic event exposure are more likely to drop out of treatment but benefit from treatment with similar symptom remission. Traumatic history was associated with greater relapse posttreatment.
Topics: Humans; Stress Disorders, Post-Traumatic; Feeding and Eating Disorders; Treatment Outcome
PubMed: 36916450
DOI: 10.1002/eat.23933